Janeway spots: What are they? Symptoms, Causes, Treatment and Differences

They occur mainly on the palms of the hands and the soles of the feet, including the thenar and hypothenar eminences, that is, at the base of the thumb and little finger, respectively.

They tend to last for days or weeks before fully healing. They are most commonly seen in acute endocarditis when bacteria such as Staphylococcus aureus can be cultured.

Histology is generally consistent with septic microembolism. Therefore bacteria can be found within the blood vessels, which makes a difference from Osler’s nodules because Janeway’s spots are not sensitive. Consequently, they are often hemorrhagic (bleed into the skin).

In conclusion, Janeway spots are described as an accumulation of pus that has been generated within the tissues of the body with a marked localized death of living and filtered tissue that is inflamed and does not affect the epidermis.

These macules are only a few millimeters in diameter. Janeway spots are distal, flat, ecchymotic, and painless, hence the leakage of blood into the tissues of the ruptured blood vessels.

Edward Janeway (1841-1911) named these lesions or spots. He was a prominent American physician and pathologist who initially described the lesions and, after a brief investigation, called them “Janeway spots.”

Place of appearance of Janeway’s spots

Among the zones or areas where these lesions appear, the following can be mentioned:


  • Under the nails where there are small areas of bleeding, which is also called splinter hemorrhage.
  • There are reddish and painless patches of skin in the concave, expanded, and flat part of the palms of the hands, between the bases of the fingers, the wrist, and the soles.
  • There are red, painful nodes when touched on the fingertips and feet, and they are similar to Osler’s nodes but still belong to the Janeway type of spots.


Symptoms of these lesions include:

  • Swelling and swelling of the feet, legs, and back of the abdomen.
  • There is very high shortness of breath during light or challenging activities or daily exercise routines.
  • Irregular, injured, and diseased spots on the skin of the hands and feet.
  • Painless but painful skin spots in Osler’s nodules.
  • The color of skin lesions may change from reddish to purple.

Causes of Janeway spots

These lesions are caused by infected and contaminated particles circulating in the blood and the deposition of bacteria, forming an area of ​​inflamed tissue that fills with pus.

Therefore, Janeway spots are caused by bacteria that have spread from an infection of the heart’s lining.

These lesions or spots and Osler’s nodules can occur due to a cutaneous immune complex-mediated by vasculitis, which is only present in about 25% of patients with inflammation of the membrane of the heart and its valves.

Common conditions caused by Janeway stains include:

  • Causada por la endocarditis Staphylococcus aureus.
  • By septic pistons.

Meanwhile, Osler’s nodules result from the deposition of immune complexes. The resulting inflammatory response produces swelling, redness, and pain characteristic of these lesions.

If not treated in time, severe and deadly infections are prone to becoming aggressive and even cause death.


Treatment depends mainly on the causative agent. If it occurs due to infection, broad-spectrum antibiotics such as:

  • Aminoglucósidos.
  • Fluoroquinolones.
  • Macrolides.
  • Among others.

The important thing is to eradicate the infection. Medical evaluation is also necessary to determine treatment dosage.

Neem oil and eucalyptus oil are supposed to be very effective in removing Janeway spots, but no health authority, medical study, or scientific proves it.

Janeway spots and Osler’s nodules

According to pathology research, Janeway spots are similar to Osler’s nodes. Still, Osler’s nodes are painful when touched with the tip of the finger or simply if pressure is exerted on them.